In recent years families have increasingly assumed responsibility for the care of their family members with severe mental illness. One documented impact of the chronic stress associated with this care giving function is the experience of burden. Other studies, primarily from the dementia caregiver literature, suggest links between caring for a spouse with a mental disability, coping, social support, and health. Although few studies have evaluated the long-term impact of caring for a family member with mental illness, there is reason to believe that similar outcomes would be observed. Psychoeducational groups, including multi-family groups (MFGs), reduce patient symptoms and may also reduce family burden. However, the mechanisms of effect are not known and a longitudinal analysis of the underlying mediators has not been undertaken. Further, the impact of psychoeducational groups on family caregiver emotional and physical health outcomes has not been studies. The purpose of this study is to assess the impact of the MFG intervention on selected family caregiver as well as patient outcomes and to investigate the mechanisms of the intervention. Using a randomized clinical trials design, MFG outcomes for 144 families and t heir family members with severe mental illness (n=64/MFG; 80 controls) will be compared over a two year period to those from current programming in a large community mental health center. Repeated assessment will include measurement of both patient and family caregiver outcomes. Patient assessment will include positive and negative symptoms, relapse, and quality of life. Caregiver assessment at 0, 12, and 24 months will include emotional distress, burden and health status. In addition, the study will determine whether and to what extent, MFG-induced alterations in caregiver health status are mediated by increased social support, improved coping, and fewer patient symptoms through reduced caregiver burden. MFG's are hypothesized to reduce family burden and distress by improving patient functioning, family coping and increasing social networking. From a chronic stress model, such MFG-induced changes are predicted to result in improved caregiver physical health. The mechanisms responsible for the improved physical and mental health outcomes brought about by the MFG intervention will be characterized through longitudinal analysis using path analysis, random regression and structural equation modeling techniques.